Unique morphology of intraoperative measurement of distal femur in northern malaysian females and its correlation with total knee arthroplasty implant sizing / Morfología única de la medición intraoperatoria del fémur distal en mujeres del norte de malasia y su correlación con el tamaño del implante en artroplastia total de rodilla

SUMMARY: Accurate implant sizing is one of the major determinants in defining the success of total knee arthroplasty (TKA). Current TKA implants are based on Caucasian knee morphometry which is well documented to be larger than Asian knees. Even more, with regards to sizing, implant mismatch tends to be more evident in the female population. This study was designed to evaluate the distal femur dimensions of Malaysian female patients who underwent TKA in our institution and to compare them with the current prosthetic system in use. A total of 199 female patients (207 knees) who underwent TKA were enrolled in this study. Intraoperatively, the AP dimensions (medial and lateral condyles) and mediolateral (ML) width were measured. Known dimension of the femoral component of the prosthetic knee system currently in use were compared with the morphological data. The average femoral component overhang was 2.11 mm (SD 3.94 mm). There was significant difference between the mean ML width of the resected femur and the femoral component (p<0.01). Analysis also revealed a significant positive and weak relationship between both, AP (medial and lateral) and ML dimension. The aspect ratio (ML/AP) of the native femur was generally smaller than the implant aspect ratio which is likely to cause overhang in our population. In general, this study shows that the knees of our female sub-population are even narrower than the other Asian female knees from previous studies. Implants should be designed based on the morphological data of the local population. Implant manufactures should tailor them to accommodate a smaller change in ML width for an increment in the AP length and provide several ML widths for one AP length to obtain a better fitting prosthesis hence curbing the problem of ML overhang.

RESUMEN: El tamaño exacto del implante es uno de los principales determinantes para definir el éxito de la artroplastía total de rodilla (ATR). Los implantes de TKA se basan en la morfometría de rodilla caucásica, cuyo tamaño está reportado como mayor que las rodillas asiáticas. Más aún, en lo que respecta al tamaño, el desajuste de los implantes tiende a ser más evidente en la población femenina. Este estudio fue diseñado para evaluar las dimensiones del fémur distal de pacientes mujeres malasias que se sometieron a ATR en nuestra institución y compararlas con el sistema protésico actual. En este estudio se incluyeron un total de 199 pacientes (207 rodillas) que se sometieron a ATR. Intraoperatoriamente, se midieron las dimensiones AP (cóndilos medial y lateral) y el ancho mediolateral (ML). Se comparó la dimensión conocida del componente femoral del sistema protésico de rodilla actualmente en uso con los datos morfológicos. El voladizo o sobresaliencia del componente femoral fue de 2,11 mm (DE 3,94 mm). Hubo una diferencia significativa entre el ancho ML medio del fémur resecado y el componente femoral (p <0,01). El análisis también reveló una relación significativa positiva y débil entre las dimensiones AP (medial y lateral) y ML. La relación de aspecto (ML / AP) del fémur nativo fue más pequeña que la relación de aspecto del implante, lo que probablemente cause un voladizo en nuestra población. En general, este estudio muestra que las rodillas de nuestra subpoblación femenina son incluso más estrechas que otras rodillas de mujeres asiáticas reportadas en estudios anteriores. Los implantes deben ser diseñados en base a los datos morfológicos de la población local. Los fabricantes de implantes deben adaptarlos a un cambio más pequeño en el ancho de ML para un incremento en la longitud AP y proporcionar varios anchos ML para una longitud AP con el objetivo de obtener una prótesis de mejor ajuste y frenar el problema del voladizo ML.

Does neuromuscular exercise training improve proprioception in ankle lateral ligament injury among athletes? Systematic review and meta-analysis / O treinamento neuromuscular melhora a propriocepção em lesão ligamentar lateral do tornozelo entre atletas? Revisão sistemática e metanálise

AIMS: The prevalence rate of ankle complexities is increasing at a constant rate among athletes. This study aimed to systematically describe the facts and findings related to the effectiveness of training programs on proprioception among athletes suffering from ankle ligament injury. METHODS: A literature search in online libraries ( Google Scholar, PubMed, EBSCOhost, and ProQuest) using different search engines was conducted for the systematic review and meta-analysis. The common keywords included NEUROMUSCULAR, EXERCISE, TRAINING, PROPRIOCEPTION, and ATHLETES. Studies related to the topic, having relevant resources, and published within the past 10 years were used as inclusion criteria. Methodological quality was assessed through PEDro scale. A meta-analysis of the selected trials was conducted to assess the effectiveness of intervention. RESULTS: Two hundred research articles were initially selected. After close scrutiny, 15 articles were included. Five moderate to excellent quality trials were selected, which involved 2,459 participants. It has been mainly identified that ankle sprain and its complications can be easily prevented with the help of training programs (five trials, relative risk: 0.69, 96%CI: 0.65-0.87). A statistically significant relationship was identified among athletes regarding the preventive impacts of training on proprioception. CONCLUSIONS: Preventive training programs were helpful for athletes in terms of proprioception, thus reducing the risk of ankle sprains.

OBJETIVOS: A taxa de prevalência de lesões no complexo ligamentar lateral vem aumentando entre os atletas a uma velocidade constante. Este estudo teve por objetivo descrever sistematicamente os achados relacionados à eficácia dos programas de treinamento na propriocepção entre atletas com lesão ligamentar do tornozelo. MÉTODOS: Foi realizada uma busca em bases de dados online ( Google Scholar, PubMed, EBSCOhost e ProQuest) com o uso de diferentes mecanismos de busca, para revisão sistemática e metanálise. Os descritores comuns foram NEUROMUSCULAR, EXERCISE, TRAINING, PROPRIOCEPTION, and ATHLETES. Os estudos relacionados ao assunto, os que continham recursos relevantes e aqueles publicados nos últimos 10 anos foram usados como critério de inclusão. A qualidade metodológica foi avaliada pela escala PEDro. Foi feita uma metanálise dos estudos selecionados a fim de avaliar a eficácia da intervenção. RESULTADOS: Inicialmente, foram selecionados 200 artigos de pesquisa. Após uma avaliação detalhada, restaram 15 artigos. Cinco estudos de qualidade moderada a excelente foram selecionados, totalizando 2.459 participantes. Verificou-se, principalmente, que o entorse de tornozelo e suas complicações podem ser evitados facilmente com o auxílio de programas de treinamento (cinco estudos, risco relativo: 0,69, IC 96%: 0,65-0,87). Observou-se uma relação estatisticamente significativa em termos dos efeitos preventivos do treinamento na propriocepção entre atletas. CONCLUSÕES: Os programas de treinamento preventivos foram úteis aos atletas em termos de propriocepção, reduzindo o risco de entorses de tornozelo.